What is the prognosis of C2 fractures?

Follow-up is critical for any patient sustaining a C2 fracture. In addition to the clinical examination, repeat imaging studies are warranted. Generally, the various treatment modalities used for C2 fractures are quite successful. The only outcome data currently available are for surgical treatment of type II odontoid fractures. A meta-analysis showed that single screw odontoid fixation using the anterior approach yielded better results than those found with transarticular fusion, multiple screws, or closed reduction with halo vest immobilization.

Parker et al retrospectively reviewed the records of 167 patients who underwent posterior cervical fusion with either C2 pedicle (PD) or C2 translaminar (TL) screw fixation and found that breach of PD screws occurred more frequently.
[2] In total, 152 TL screws and 161 PD screws were placed. Thirty-one cases of axial cervical fusion (C1-C2 or C1-C3) were performed with TL (16) or PD (15) screw fixation, and 136 cases of subaxial cervical fusion (C2-caudal) were performed with TL (66) or PD (70) fixation.

Omesis et al found that C2 fractures in the elderly (>70 years) can be treated surgically with both anterior and posterior approaches with acceptable morbidity and mortality and that the majority of patients can be mobilized early and return to their previous levels of independence. Of 29 patients who had undergone surgical treatment for C2 fractures, 25 (86.2%) were able to return to their previous environment.
[3]

Chen et al retrospectively compared operative versus nonoperative treatment of closed C2 fractures without spinal cord injury in elderly patients. The primary outcomes of this study were 30-day mortality and complication rates, with length of hospital stay and long-term survival measured as secondary outcomes. The conclusion of this review was that elderly patients faced high morbidity and mortality regardless of the type of treatment, and they should not be excluded from the surgical treatment option based solely on their age.
[4]

Nizare et al did a retrospective review of the management of 70 patients with various upper cervical spine injuries. They concluded that on the basis of the good radiologic and clinical improvement of the trauma victims, early management of cervical spine injuries could optimize the final outcome.
[5]

Stulik et al analyzed the management and prognosis of pediatric patients with unstable upper cervical spine injuries. They found that the majority of these injuries (91.3%) were treated operatively, with the posterior approach used in about two thirds of the patients and the anterior in the remaining one third. The important finding of their study was that despite the relative frequency of neurologic deficits in pediatric patients with unstable upper cervical injuries, they had a better prognosis than adults, especially for the youngest children with mild deficits. The recommendation from the authors is that therapy for these children should be strictly individualized to maximize positive outcomes.
[6]

Three types of C2 odontoid fractures: type I is an oblique fracture through the upper part of the odontoid process; type II is a fracture occurring at the base of the odontoid as it attaches to the body of C2; type III occurs when the fracture line extends through the body of the axis.

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health<br/>Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston